Civil Remedy Filing

Civil Remedy Notice of Insurer Violations

Filing Number: 801008

Filing Accepted: 1/14/2025

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Complainant

Last/Business Name *

FITY DOLLAR EYE GUY

First Name

Street Address *

5328 N. DAVIS HWY.

City, State Zip *

PENSACOLA, FL 32503

Email Address *

MARKTEGENKAMP@GMAIL.COM

Complainant Type: *

Insured

Last/Business Name*		FIFTY DOLLAR EYE GUY		First Name
Policy # *		LBW550430R3		Claim #*		2008313

Attorney

Attorney is Applicable

Last Name*	BRANKAMP First Name * JOSHUA Initial
Street Address*		8751 W. BROWARD BLVD., STE. 203
City, State Zip*		PLANTATION , FLORIDA 33324
Email Address *		JOSHUA@G-GLAWGROUP.COM

Violation

Insurer Type *		Authorized Insurer Unauthorized Insurer

Insurer Name
Insurer Name*		UNDERWRITERS AT LLOYD'S, LONDON
Insurer Name*
Street Address*
City, State Zip*		,
NAIC Company Code

Name of individual responsible for violation (if any):* MICAH BRADFORD; BRADY DUGAN; AND OTHER UNIDENTIFIED INDIVIDUALS
Type of Insurance * Commercial Property & Casualty

Reason for Notice *

	Unfair Trade Practice
	Other : Bad Faith
	Claim Delay
	Unsatisfactory Settlement Offer

* Statutory provision(s) which the insurer allegedly violated.

	624.155(1)(b)(1)		Not attempting in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests.
	624.155(1)(b)(2)		Making claims payments to insureds or beneficiaries not accompanied by a statement setting forth the coverage under which payments are being made.
	624.155(1)(b)(3)		Except as to liability coverages, failing to promptly settle claims, when the obligation to settle a claim has become reasonably clear, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage.
	626.9541(1)(i)(3)(a)		Failing to adopt and implement standards for the proper investigation of claims.
	626.9541(1)(i)(3)(b)		Misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue.
	626.9541(1)(i)(3)(c)		Failing to acknowledge and act promptly upon communications with respect to claims.
	626.9541(1)(i)(3)(e)		Failing to affirm or deny full or partial coverage of claims, and, as to partial coverage, the dollar amount or extent of coverage, or failing to provide a written statement that the claim is being investigated, upon the written request of the insured within 30 days after proof-of-loss statements have been completed.
	626.9541(1)(i)(3)(f)		Failing to promptly provide a reasonable explanation in writing to the insured of the basis in the insurance policy, in relation to the facts or applicable law, for denial of a claim or for the offer of a compromise settlement.
	626.9541(1)(i)(3)(g)		Failing to promptly notify the insured of any additional information necessary for the processing of a claim.
	626.9541(1)(i)(4)		Failing to pay undisputed amounts of partial or full benefits owed under first-party property insurance policies within 60 days after an insurer receives notice of a residential property insurance claim, determines the amounts of partial or full benefits, and agrees to coverage, unless payment of the undisputed benefits is prevented by factors beyond the control of the insurer as defined in s. 627.70131(5).
	626.9541(1)(i)(3)(i)		Failing to pay personal injury protection insurance claims within the time periods required by s. 627.736(4)(b).

* Specific policy language that is relevant to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

The violations, actions, and omissions asserted herein regarding Certain Interested Underwriters at Lloyd’s, London Subscribing to Policy Number LBW550430R3 (“Underwriters”)’s bad faith actions, omissions, and conduct are predicated upon the facts and circumstances asserted in the section below designated for same, upon Florida case law, and upon violations of the provisions of the Florida Insurance Code and Florida Administrative Code upon which the bad faith statutes contained within Sections 624.155 & 626.9541, Florida Statutes, are based. That said, the following Policy terms and provisions are relevant to Underwriters’ statutory violations and bad faith conduct: D. The Loss Payment Condition dealing with the number of days within which we must pay for covered loss or damage is replaced by the following: Provided you have complied with all the terms of this Coverage Part, we will pay for covered loss or damage upon the earliest of the following: (1) Within 20 days after we receive the sworn proof of loss and reach written agreement with you; (2) Within 30 days after we receive the sworn proof of loss and: (a) There is an entry of a final judgment; or (b) There is a filing of an appraisal award with us; or (3) Within 90 days of receiving notice of an initial, reopened or supplemental claim, unless we deny the claim during that time or factors beyond our control reasonably prevent such payment. If a portion of the claim is denied, then the 90-day time period for payment of claim relates to the portion of the claim that is not denied. Paragraph (3) applies only to the following: (a) A claim under a policy covering residential property; (b) A claim for building or contents coverage if the insured structure is 10,000 square feet or less and the policy covers only locations in Florida; or (c) A claim for contents coverage under a tenant's policy if the rented premises are 10,000 square feet or less and the policy covers only locations in Florida. I. The following definition of structural damage is added with respect to the coverage provided under this endorsement: "Structural damage" means a covered building, regardless of the date of its construction, has experienced the following. 1. Interior floor displacement or deflection in excess of acceptable variances as defined in ACI 117-90 or the Florida Building Code, which results in settlement related damage to the interior such that the interior building structure or members become unfit for service or represent a safety hazard as defined within the Florida Building Code; 2. Foundation displacement or deflection in excess of acceptable variances as defined in ACI 318-95 or the Florida Building Code, which results in settlement related damage to the primary structural members or primary structural systems that prevents those members or systems from supporting the loads and forces they were designed to support to the extent that stresses in those primary structural members or primary structural systems exceed one and one-third the nominal strength allowed under the Florida Building Code for new buildings of similar structure, purpose, or location; 3. Damage that results in listing, leaning, or buckling of the exterior load bearing walls or other vertical primary structural members to such an extent that a plumb line passing through the center of gravity does not fall inside the middle one-third of the base as defined within the Florida Building Code; 4. Damage that results in the building, or any portion of the building containing primary structural members or primary structural systems, being significantly likely to imminently collapse because of the movement or instability of the ground within the influence zone of the supporting ground within the sheer plane necessary for the purpose of supporting such building as defined within the Florida Building Code; or Windstorm or Hail Deductible Percentage 3% Building and Personal Property Coverage Form We will pay for direct physical loss of or damage to Covered Property at the premises described in the Declarations caused by or resulting from any Covered Cause of Loss. 2. Appraisal If we and you disagree on the value of the property or the amount of loss, either may make written demand for an appraisal of the loss.… The appraisers will state separately the value of the property and amount of loss. If they fail to agree, they will submit their differences to the umpire. A decision agreed to by any two will be binding. 4. Loss Payment a. In the event of loss or damage covered by this Coverage Form, at our option, we will either: (1) Pay the value of lost or damaged property; (2) Pay the cost of repairing or replacing the lost or damaged property, subject to b. below; (3) Take all or any part of the property at an agreed or appraised value; or (4) Repair, rebuild or replace the property with other property of like kind and quality, subject to b. below. We will determine the value of lost or damaged property, or the cost of its repair or replacement, in accordance with the applicable terms of the Valuation Condition in this Coverage Form or any applicable provision which amends or supersedes the Valuation Condition. c. We will give notice of our intentions within 30 days after we receive the sworn proof of loss. g. We will pay for covered loss or damage within 30 days after we receive the sworn proof of loss, if you have complied with all of the terms of this Coverage Part, and: (1) We have reached agreement with you on the amount of loss; or (2) An appraisal award has been made. 7. Valuation We will determine the value of Covered Property in the event of loss or damage as follows: a. At actual cash value as of the time of loss or damage, except as provided in b., c., d. and e. below. e. Tenants' Improvements and Betterments at: (1) Actual cash value of the lost or damaged property if you make repairs promptly. (2) A proportion of your original cost if you do not make repairs promptly. We will determine the proportionate value as follows: (a) Multiply the original cost by the number of days from the loss or damage to the expiration of the lease; and (b) Divide the amount determined in (a) above by the number of days from the installation of improvements to the expiration of the lease. All Loss Payment provisions.

* Facts and circumstances giving rise to the violation.
Enter all words or phrases (one at a time) that should be used to filter.

This Civil Remedy Notice is being given to perfect the claimant Fifty Dollar Eye Guy’s right to pursue any and all of the civil remedies authorized by Section 624.155 of the Florida Statutes. In addition to the above statutory and policy provisions alleged to have been violated, the following statutes and rules have been violated by Certain Interested Underwriters at Lloyd’s, London Subscribing to Policy Number LBW550430R3 (“Underwriters”): 69B-220.201(3)(b)(2) An adjuster shall adjust all claims strictly in accordance with the insurance contract; 69B-220.201(3)(c) An adjuster shall not approach investigations, adjustments, and settlements in a manner prejudicial to the insured; 69B-220.201(3)(d) An adjuster shall make truthful and unbiased reports of the facts after making a complete investigation; 69B-220.201(3)(e) An adjuster shall handle every adjustment and settlement with honesty and integrity, and allow a fair adjustment or settlement to all parties; 69B-220.201(3)(f) An adjuster, upon undertaking the handling of a claim, shall act with dispatch and due diligence in achieving a proper disposition of the claim; 69B-220.201(3)(j) An adjuster shall not knowingly fail to advise a claimant of the claimant’s claim options in accordance with the terms and conditions of the insurance contract; 69B-220.201(3)(k) An adjuster shall not undertake the adjustment of any claim concerning which the adjuster is not currently competent and knowledgeable as to the terms and conditions of the insurance coverage, or which otherwise exceeds the adjuster’s current expertise; 626.877 Every adjuster shall adjust or investigate every claim, damage, or loss made or occurring under an insurance contract, in accordance with the terms and conditions of the contract and of the applicable laws of this state; 626.9744(1) When a loss requires repair or replacement of an item or part, any physical damage incurred in making such repair or replacement which is covered and not otherwise excluded by the policy shall be included in the loss to the extent of any applicable limits. The insured may not be required to pay for betterment required by ordinance or code except for the applicable deductible, unless specifically excluded or limited by the policy. The claimant/insured, Fifty Dollar Eye Guy (the “Insured”), purchased an insurance policy (the “Policy”) from Certain Interested Underwriters at Lloyd’s, London Subscribing to Policy Number LBW550430R3 (“Underwriters”) with effective dates of coverage for the date of loss in question (including 09/16/2020) and bearing Policy Number LBW550430R3. The Policy includes the subject premises located at 5328 N. Davis Hwy., Pensacola, FL 32503 (the “Property”). On or about 09/16/2020, the Property sustained serious covered damage as a result of Hurricane Sally, Cat 3 water, and wind speeds higher than 85 mph, which bent metal frames at the Property. The Insured timely notified Underwriters of the loss (at least by 10/06/2020), and Underwriters assigned Claim Number 2008313 (the “Claim”). Underwriters purportedly retained Minuteman Adjusters (“Minuteman”) as third-party administrators, and Minuteman apparently assigned a separate field adjustment company to investigate the claim. One field adjuster, Roger Junet, informed the Insured’s principal that this was a serious and very significant claim in terms of money damages in terms of the building alone, that his estimate would easily be in the hundreds of thousands of dollars for the building and roof alone, and that the carrier would need to immediately pay hundreds of thousands of dollars. On 03/25/2021, Minuteman wrote to the Insured in part, “we retained a local field adjuster to inspect the property and report their findings. They have determined your loss was caused by Hurricane. As we have found damage to covered property from a covered cause of loss, payment is appropriate. Alacrity Solutions Group, LLC provided the enclosed estimate of the damage.” The same letter states that the ACV and RCV are $248,001.37 broken down as follows: “Building ($48,001.37), Advance Business Personal Property ($200,000.00) which represents the Net Claim payment for the undisputed covered damages.” This was a far cry from what Mr. Junet told the Insured’s principal during his site visit. Accordingly, the Insured responded by providing Underwriters with evidence of their dispute as to the value of the Claim. Then, on or about 08/03/2021, the Insured demanded Appraisal and identified its appraiser. On 04/12/2022, the Insured’s appraiser and the Umpire executed an Appraisal Award in the total amount of $1,192,839.23 RCV/$952,976.68 ACV in relation to the Claim, based on the Umpire’s estimate. The Appraisal Award included $277,569.70 RCV/$261,387.04 ACV for building damage, $222,601.04 RCV/$207,080.52 ACV for betterments, and $692,668.49 RCV/$484,509.12 ACV for business personal property. The amount of the Appraisal Award, and Mr. Junet’s original verbal assessment, raise the question why Underwriters’ original building payment was so low, and why the Insured was forced to wait nearly two years, and incur heavy additional costs and fees, to secure the additional building payment through Appraisal. Mr. Junet’s original verbal assessment also raises the question whether Underwriters changed or altered Mr. Junet’s initial estimate. Additionally, Underwriters allegedly and purportedly issued payment to the Insured in the amount of $583,375.71 ACV for the amounts “due on the Appraisal Award,” by letter dated 05/10/2022. Underwriters, however, did not in fact timely or properly issue payment to the Insured for the amounts due on the Appraisal Award, but rather Underwriters (i) applied one or more higher deductibles than what the Policy provided for; (ii) failed to describe or otherwise explain how the deductibles were calculated and determined; (iii) failed to cite to or otherwise set forth the terms or provisions of the Policy upon which the deductibles were calculated, determined, or based; and (iv) included “Phelps Dunbar LLP Attn Michael Rinaldi” (i.e., Underwriters’ attorneys) as a payee(s) on the checks, which prevented the Insured from depositing or otherwise negotiating the checks. At or around that same time, the Insured had a pending Civil Remedy Notice. On 05/11/2022, Underwriters informed the Florida Department of Financial Services that the issuance of the above-referenced checks “cured” the violations alleged in the Civil Remedy Notice. Underwriters knowingly and deliberately (i) lowballed the Insured (ii) failed to include in its estimate certain covered damage and damaged areas of the Property, (iii) failed to include certain damaged business personal property, (iv) failed to include certain damaged betterments and improvements, and (v) failed to include other aspects of the Claim. As for the damage that it did include in its estimate, Underwriters under-scoped that damage. Underwriters either performed only a cursory inspection of the Property, and/or it might have changed or altered the field adjuster’s estimate (there is evidence to support this). Underwriters failed to retain experts necessary to identify the repairs necessary to restore the Property and put the Insured back to where it was prior to the loss in compliance with the terms of the Policy. Underwriters lowballed the Insured by failing and refusing to provide an estimate encompassing all covered damages. There were missing line items that would have significantly increased Underwriters’ payment to the Insured without the need for Appraisal. And the Insured had to wait more than a year and a half to obtain more significant payments from Underwriters through the relatively expensive Appraisal process. As evidenced by the Appraisal Award, Underwriters “low-balled” and “stonewalled” the Insured for a significant period of time to attempt to force it to settle for less than what it was owed under the Policy. Due to Underwriter’s failure to properly adjust and pay the full amount of the Insured’s Claim (which is evidenced by the Appraisal Award and Mr. Junet’s representations), and due to Underwriters’ failure to adopt and implement standards for the proper investigation of claims (which is also evidenced by the Appraisal Award), the Insured continues to be damaged and to incur damages. The obligation to pay the full value of the Insured’s Claim was made clear to Underwriters years ago based on the facts and evidence available, yet Underwriters failed to pay the full value of the Insured’s Claim. By relying upon an ill-conceived, sketchy, result-oriented, and biased Claim evaluation, with no or barely any relevant principles, methods, or measurements, and by refusing to provide prompt and full payment in violation of the Policy’s Loss Settlement and Loss Payment provisions, Underwriters failed to implement standards for the proper investigation of a claim in violation of Florida Statute 626.9541(1)(i)(3)(a). Underwriters was obligated to make its coverage determinations based upon reasonable explanations and reasonable investigations. In holding back payment, Underwriters attempted to “strong-arm” the Insured into accepting a payment less than what it was owed under the Policy. The payment delay and bad-faith conduct resulted in additional extra-contractual damages. Underwriters also appears to have miscalculated the deductible. In summary, Underwriters’ failures relating to the Insured include the following, without limitation, 1) FAILURE TO PAY THE CLAIM IN FULL; 2) FAILURE TO PROMPTLY INVESTIGATE THE CLAIM; 3) FAILURE TO PROPERLY ADJUST THE LOSS; 4) FAILURE TO ACT IN DUE DILIGENCE AND GOOD FAITH TO RESOLVE THE CLAIM; 5) PLACING FINANCIAL INTEREST OF THE INSURER BEFORE THAT OF THE POLICYHOLDERS; 6) FAILURE TO PROPERLY TRAIN, EVALUATE AND MANAGE ADJUSTERS; 7) LOOKING FOR WAYS TO PAY LESS, DELAY PAYMENT AND OTHERWISE “LOW BALL” OR “STONEWALL” THE CLAIM; AND 8) THE REASONS FOR THESE MAY BE ATTRIBUTED TO IMPROPER TRAINING, SUPERVISION, AND/OR MOTIVATION OF ADJUSTERS AND CLAIMS SUPERVISORS. THE INSURER APPEARS TO HAVE FAILED TO ADOPT PROPER STANDARDS FOR INVESTIGATION AND ADJUSTMENT OF LOSSES. The foregoing is evidence of bad faith conduct on the part of Underwriters. As a direct and proximate result of Underwriters' handling of the Claim, the Insured sustained extra-contractual damages, including, but not limited to, attorneys’ fees and costs. Underwriters, as part of its routine business pattern and practices, employs outcome-oriented adjusters/vendors/experts who purposely looked for ways to minimize coverage instead of affording coverage to its policyholders, such as the Insured. In contrast to the legislative intent which motivated the enumeration of an insurance adjuster’s responsibilities outlined in the Florida Administrative Code, the Insured was not afforded the professional duties entrusted and imposed on Underwriters by the Public Trust. The outcome-oriented claim adjustment practices undertaken by Underwriters led to its failure to adequately adjust the Claim. In order to remedy the above defects, within the 60-day cure period Underwriters must issue payment to the Insured in the amount of $577,494.92, which includes the following: the difference between the Insured’s appraiser’s ACV estimate and the total ACV amount in the Appraisal Award (i.e., $444,068.00); interest on $583.375.71 from 3/25/2021 to 5/10/2022 (i.e., $28,046.02); the appraisal fee (i.e., $17,501.27); and the public adjuster’s fee and associated costs incurred (i.e., $87,879.45). Insured reserves the right to seek attorney’s fees and additional costs in the event that the Insured files suit against Underwriters.

Comments

User Id		Date Added		Comment
kyle.gretel@phelps.com		03-14-2025		To Whom It May Concern: We write on behalf of Certain Underwriters at Lloyd’s, London Subscribing to Policy No. LBW550430R3 (“Underwriters”), the commercial property insurers for Fifty Dollar Eye Guy (the “Insured”) under Policy Number LBW550430R3, with effective dates of December 2, 2019, to December 2, 2020 (the “Policy”). We write on Underwriters’ behalf in response to the Civil Remedy Notice of Insurer Violations (“the Notice”) submitted to the Department of Financial Services, Division of Consumer Services (“the Department”) by Joshua W. Brankamp, Esq. on behalf of the Insured. The Notice bears filing number 801008, with an acceptance date of January 14, 2025. In the Notice, Mr. Brankamp, on behalf of the Insured, alleges that Underwriters violated 11 sections of the Florida Statutes, including two statutes that are inapplicable to commercial property insurance claims, with regard to the Insured’s claim under the Policy for alleged damage to the insured commercial property located at 5328 N Davis Hwy, Pensacola, FL 32503 (the “Property”), which reportedly occurred on September 16, 2020 (the “Loss”). The Notice generally alleges that the “Reasons for Notice” are “Unfair Trade Practice, Bad Faith, Claim Delay, Unsatisfactory Settlement Offer.” Underwriters categorically deny that they or any of their representatives engaged in any prohibited conduct or violated any of the statutes referenced in the Notice with respect to this claim. The Notice is invalid for its failure to specifically allege the Policy provisions in accordance with the requirements of section 624.155(3)(b)(4), Florida Statutes. Further, the Notice is vague and deficient in that it fails to describe the facts and circumstances giving rise to the alleged statutory violations. The Notice is also deficient because it does not state with specificity what Underwriters must do to “cure” the violations alleged in the Notice as required by Florida law and, therefore, does not offer a valid “cure”. Additionally, the “cure” alleged in the Notice includes items that are not recoverable under the Policy. Finally, Underwriters timely paid the Appraisal Award entered in this matter, which set and resolved the Insured’s contractual claim. The Notice is legally deficient, and Underwriters respectfully request that the Notice be rejected by the Department. Despite the deficiencies in the Notice, Underwriters acted in good faith, without delay, and with due regard for the Insured’s interests at all times during the investigation, handling, and adjustment of the Insured’s claim, to resolve the dispute pursuant to the terms of the Policy. A detailed response to the Notice, including discussion of deficiencies in the Notice and Underwriters’ good faith attempts to “cure” the allegations in the Notice, was sent via e-mail to the Insured c/o counsel of record on Friday, March 14, 2025. If the Department has any questions or requires any additional information, including a copy of the detailed response to the Notice provided to the Insured’s counsel, please contact us. Sincerely, /s/ Kyle A. Gretel Kyle A. Gretel, Esq. Phelps Dunbar LLP 100 South Ashley Drive Suite 2000 Tampa, FL 33602 E-mail: kyle.gretel@phelps.com

Acknowledgement
*	The submitter hereby states that this notice is given in order to perfect the rights of the person(s) damaged to pursue civil remedies authorized by Section 624.155, Florida Statutes. Before submitting a Notice using this system, please verify that all text has been entered correctly and completely. Once the Notice has been submitted, the text cannot be changed or deleted.

DFS-10-363
Rev. 10/14/2008